Parasitology

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PARASITOLOGYPARASITOLOGY Protozoa and HelminthsProtozoaand Helminths Dr. Ashish V. JawarkarDr. Ashish V. Jawarkar M.D.M.D.

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ParasitesParasites ►Organisms which aredependent on otherOrganisms which are dependent on other organisms for survivalorganisms for survival ►EukaryotesEukaryotes ►Unicellular – ProtozoaUnicellular – Protozoa ►Multicellular - HelminthsMulticellular - Helminths

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►Host – organismthat provides nutrition toHost – organism that provides nutrition to parasiteparasite ►Definitive host – adult stage of parasite isDefinitive host – adult stage of parasite is lodged – undergoes sexual reproduction –lodged – undergoes sexual reproduction – both males and females are presentboth males and females are present ►Intermediate host – harbours larval stage ofIntermediate host – harbours larval stage of helminths, asexual reproduction of protozoahelminths, asexual reproduction of protozoa

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For toxoplasmaFor toxoplasma

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PROTOZOAPROTOZOA

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ProtozoaProtozoa ►Classified according toorgan of motilityClassified according to organ of motility ►Pseudopodia – amoebaPseudopodia – amoeba ►Cilia – ciliatesCilia – ciliates ►Flagella – flagellatesFlagella – flagellates ►Sporozoa (non motile)Sporozoa (non motile)

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► AmoebaAmoeba  Ehistolytica, N. fowleriE histolytica, N. fowleri ► FlagellatesFlagellates  GiardiaGiardia  T. vaginalisT. vaginalis  LeishmaniaLeishmania ► SporozoaSporozoa  PlasmodiumPlasmodium  ToxoplasmaToxoplasma ► CiliatesCiliates  B. coliB. coli

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Classification according tosite ofClassification according to site of infectioninfection ►IntestineIntestine  E histolyticaE histolytica  G. lambliaG. lamblia ►Genital tractGenital tract  T. vaginalisT. vaginalis ►BloodBlood  PlasmodiumPlasmodium  L. donovaniL. donovani

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Entamoeba HistolyticaEntamoeba Histolytica

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Entamoeba HistolyticaEntamoeba Histolytica ►DistributionDistribution ►LocationLocation ►LifecycleLife cycle ►Diseases causedDiseases caused ►PathogenesisPathogenesis ►Lab diagnosisLab diagnosis ►TreatmentTreatment

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DistributionDistribution ►World wideWorld wide

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►DistributionDistribution ►LocationLocation ►Life cycleLife cycle ►DiseasescausedDiseases caused ►PathogenesisPathogenesis ►Lab diagnosisLab diagnosis ►TreatmentTreatment

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LocationLocation ►Parasite found inlarge intestineParasite found in large intestine

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Life cycleLife cycle ►Entirelife cycle completed in one host -Entire life cycle completed in one host - humanshumans

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Morphological formsMorphological forms ►CystsCysts Round, 10-15 micronsRound, 10-15 microns  4-6 microns nucleus4-6 microns nucleus  Highly refractile cyst wallHighly refractile cyst wall  Four or more nucleiFour or more nuclei

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TrophozoitesTrophozoites ►18-40 microns18-40 microns ►Cytoplasm– outer ectoplasm, innerCytoplasm – outer ectoplasm, inner endoplasmendoplasm ►Nucleus – 4-6 micronsNucleus – 4-6 microns ►Ingested red blood cellsIngested red blood cells

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Diseases causedDiseases caused ►Dysentry- Trophozoites burrow intoDysentry - Trophozoites burrow into intestinal wall and cause dysentry withintestinal wall and cause dysentry with ulcersulcers

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►Extra intestinal manifestationsExtraintestinal manifestations  Amebic hepatitisAmebic hepatitis  Infection of lungs/brainInfection of lungs/brain

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Lab diagnosisLab diagnosis ►DysentryDysentry Examine freshly passed stools or ulcerExamine freshly passed stools or ulcer scrapings for trophozoite formsscrapings for trophozoite forms  Iodine mount for cystsIodine mount for cysts ►Amoebic hepatitisAmoebic hepatitis  Liver aspirationLiver aspiration

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►Serological testsSerological tests ELISAELISA  IHAIHA

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TreatmentTreatment ►MetronidazoleMetronidazole

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Giardia LambliaGiardia Lamblia

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LocationLocation ►Small intestine –duodenum and upper partSmall intestine – duodenum and upper part of jejunumof jejunum

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Life cycleLife cycle ►Entirelife cycle is completed in one host -Entire life cycle is completed in one host - humanshumans

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Morphologic formsMorphologic forms ►TrophozoiteTrophozoite Shaped as a badminton/tennis racquetShaped as a badminton/tennis racquet  Two sucking discs on ventral surfaceTwo sucking discs on ventral surface  Bilaterally symmetricalBilaterally symmetrical  Two nuclei, two axostyles and four flagellaTwo nuclei, two axostyles and four flagella

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►CystCyst  Infective stageInfectivestage  Egg shapedEgg shaped

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Diseases causedDiseases caused ►steatorrhoea– excessive fat in stoolssteatorrhoea – excessive fat in stools

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PathogenesisPathogenesis ►Steatorrhoea is dueto malabsorption of fatSteatorrhoea is due to malabsorption of fat ►Disease is never invasive – no dysentryDisease is never invasive – no dysentry

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Lab diagnosisLab diagnosis ►Demonstrationof cysts and trophozoites inDemonstration of cysts and trophozoites in stoolstool

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TreatmentTreatment ►MetronidazoleMetronidazole

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Trichomonas VaginalisTrichomonas Vaginalis

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LocationLocation ►Female genital tractFemalegenital tract

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Life cycleLife cycle ►Humanbeings are the only hostHuman beings are the only host

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Morphological formsMorphological forms ►Onlyone form – trophozoiteOnly one form – trophozoite ►Pear shapedPear shaped ►Single ovoid nucleusSingle ovoid nucleus ►3-5 pairs of flagella3-5 pairs of flagella ►One axostyleOne axostyle ►One undulating mebrane formed by flagellaOne undulating mebrane formed by flagella

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Life cycleLife cycle

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Diseases causedDiseases caused ►Trichomoniasisin females which is aTrichomoniasis in females which is a sexually transmitted disease – presents assexually transmitted disease – presents as UTIUTI ►In males - urethritisIn males - urethritis

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Lab diagnosisLab diagnosis ►Demonstrateorganism in vaginal dischargeDemonstrate organism in vaginal discharge from females and urethral discharge fromfrom females and urethral discharge from malesmales ►Saline preparation shows characteristicSaline preparation shows characteristic corkscrew motilitycorkscrew motility  Please see the linkPlease see the link https://www.youtube.com/watch?v=9B1PFJXuJUshttps://www.youtube.com/watch?v=9B1PFJXuJUs for motilityfor motility

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TreatmentTreatment ►Metronidazole to bothpartnersMetronidazole to both partners

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HAEMOFLAGELLATESHAEMOFLAGELLATES LeishmaniaLeishmania PlasmodiaPlasmodia

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Leishmania DonovaniLeishmania Donovani

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DistributionDistribution ►India - endemicIndia- endemic

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LocationLocation ►Reticuloendothelial systemReticuloendothelial system Bone marrowBone marrow  LiverLiver  SpleenSpleen

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Life cycleLife cycle ►TwohostsTwo hosts  Humans – definitive host (sexual reproduction)Humans – definitive host (sexual reproduction)  Sandfly – intermediate host (asexualSandfly – intermediate host (asexual reproduction)reproduction)

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Morphologic formsMorphologic forms ►Promastigote stage –Promastigote stage –  Stage with flagellaStage with flagella  Nucleus in centreNucleus in centre  One kinetoplast at anterior endOne kinetoplast at anterior end  Flagella at anterior endFlagella at anterior end ► Amastigote stage –Amastigote stage –  Seen in humansSeen in humans  Egg shapedEgg shaped  Nucleus at centreNucleus at centre  Kinetoplast at right angleKinetoplast at right angle

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Diseases causedDiseases caused ►KalaAzar a/k/a Visceral LeishmaniasisKala Azar a/k/a Visceral Leishmaniasis ►Fever with enlargement of spleen,Fever with enlargement of spleen, lymphnodeslymphnodes

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►Misdiagnosed as malariaMisdiagnosedas malaria

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PathogenesisPathogenesis ►Affects immune systemAffectsimmune system ►Complications due to oppurtunisticComplications due to oppurtunistic infectionsinfections

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Lab diagnosisLab diagnosis ►DirectDirect Demonstration of LD body in bone marrowDemonstration of LD body in bone marrow smearssmears  Culture in NNN mediumCulture in NNN medium ►IndirectIndirect  Indirect Haemagglutination testIndirect Haemagglutination test  ELISAELISA

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TreatmentTreatment ►Amphotericin BAmphotericin B

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SPOROZOASPOROZOA PlasmodiumPlasmodium

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MalariaMalaria ► Sporozoite –no special organs of locomotionSporozoite – no special organs of locomotion ► Mal-air = Bad airMal-air = Bad air ► Plasmodium discovered by Sir Ronald Ross inPlasmodium discovered by Sir Ronald Ross in Secunderabad, APSecunderabad, AP ► Four speciesFour species  P. vivaxP. vivax  P. falciparumP. falciparum  P. ovaleP. ovale  P. malariaeP. malariae

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DistributionDistribution

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LocationLocation ►Liver cellsLiver cells ►RedBlood cellsRed Blood cells

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Life cycleLife cycle ►Definitivehost – Female anophelesDefinitive host – Female anopheles mosquitomosquito ►Intermediate host – HumansIntermediate host – Humans

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Pre erythrocytic schizogony Erythrocyticschizogony Gametogony

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Morphological formsMorphological forms ►Preerythrocytic schizogony – sporozoitesPre erythrocytic schizogony – sporozoites ►Erythrocytic schizogony – trophozoite,Erythrocytic schizogony – trophozoite, schizont and merozoiteschizont and merozoite ►Gametogony – gamets (micro and macro)Gametogony – gamets (micro and macro) ►Mosquito – ookinete, oocyst, sporozoiteMosquito – ookinete, oocyst, sporozoite

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Morphologic formsMorphologic forms ►schizontsschizonts

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Ring forms (trophozoites)Ringforms (trophozoites)

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gametocytegametocyte

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Disease causedDisease caused ►MalariaMalaria ► Fever with chills – co incides with release ofFever with chills – co incides with release of parasites in bloodparasites in blood ► SplenomegalySplenomegaly ► Hemolytic anemiaHemolytic anemia ► Black water fever – intravascular hemolysisBlack water fever – intravascular hemolysis ► Pernicious malaria – in P. falciparumPernicious malaria – in P. falciparum  Cerebral malaria – brain capillaries clogged withCerebral malaria – brain capillaries clogged with parasitesparasites  Algid malaria – liver failureAlgid malaria – liver failure  septicemiasepticemia

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PathogenesisPathogenesis ►Due to releaseof parasites in blood –Due to release of parasites in blood – cytokines are released which cause fevercytokines are released which cause fever and chillsand chills ►Hemolytic anemiaHemolytic anemia

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Lab diagnosisLab diagnosis ►Examineblood smears for ringExamine blood smears for ring forms/schizontsforms/schizonts ►Antigen detection testsAntigen detection tests

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TreatmentTreatment ►ChloroquineChloroquine ►ArtimesinArtimesin ►MefloquineMefloquine ►PrimaquinePrimaquine

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HELMINTHSHELMINTHS

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HelminthsHelminths ►Commonly called –‘worms’Commonly called – ‘worms’ ►Three groupsThree groups  Nematodes – unsegmented bodyNematodes – unsegmented body  Cestodes – segmented body – tape likeCestodes – segmented body – tape like  Trematodes – leaf like - flukesTrematodes – leaf like - flukes

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► NematodesNematodes  RoundwormRound worm  Hook wormHook worm  Thread worm/pin wormThread worm/pin worm  Filarial wormsFilarial worms ► CestodesCestodes  T. saginata – Beef tape wormT. saginata – Beef tape worm  T. solium – pork tape wormT. solium – pork tape worm  E. granulosus – Dog tape wormE. granulosus – Dog tape worm ► TrematodesTrematodes  Intestinal flukes -Intestinal flukes -  Liver flukes – C. sinensis, f. hepaticaLiver flukes – C. sinensis, f. hepatica  Lung flukes – P. westermaniiLung flukes – P. westermanii  Blood flukes – S. hematobiumBlood flukes – S. hematobium

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Round wormRound worm (AscarisLumbricoides)(Ascaris Lumbricoides) ►DistributionDistribution ►LocationLocation ►Life cycleLife cycle ►Diseases causedDiseases caused ►PathogenesisPathogenesis ►Lab diagnosisLab diagnosis ►TreatmentTreatment

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LocationLocation ►Small intestine (jejunum)Smallintestine (jejunum)

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Life cycleLife cycle ►Humansare the only hostsHumans are the only hosts

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Morphologic formsMorphologic forms ►AdultwormsAdult worms  Resemble earth wormsResemble earth worms  Male – female separateMale – female separate  2.5 to 4 cm in length, 5 mm in diameter2.5 to 4 cm in length, 5 mm in diameter  Female worm lays 2.5 lakh eggs every day!!!!!Female worm lays 2.5 lakh eggs every day!!!!!

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Morphological formsMorphological forms ►EggsEggs Bile stainedBile stained  Fertilised/unfertilisedFertilised/unfertilised  Single unsegmented ovum with clearSingle unsegmented ovum with clear crescenteric areascrescenteric areas

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Diseases causedDiseases caused ►Malabsorptionof nutrientsMalabsorption of nutrients ►CoughCough ►Intestinal obstructionIntestinal obstruction

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Lab diagnosisLab diagnosis ►StoolexaminationStool examination  eggseggs

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TreatmentTreatment ►AlbendazoleAlbendazole ►MebendazoleMebendazole

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Hook wormHook worm (AncylostomaDuodenale /(Ancylostoma Duodenale / Necator Americanus)Necator Americanus)

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DistributionDistribution ►World wideWorld wide ►Tropicaland subtropical countriesTropical and subtropical countries

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LocationLocation ►Small intestine, mainlyjejunumSmall intestine, mainly jejunum

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Life cycleLife cycle ►Onlyone host - humansOnly one host - humans

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Morphologic formsMorphologic forms ►EggsEggs Not bile stainedNot bile stained

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Adult wormsAdult worms ►1-2cm1-2 cm ►CylindricalCylindrical ►Anterior end is bent – hook likeAnterior end is bent – hook like

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Diseases causedDiseases caused ►Irondeficiency anemia due to chronic bloodIron deficiency anemia due to chronic blood lossloss

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►Itch at thesite of entry into the skinItch at the site of entry into the skin ►Cutaneous larva migransCutaneous larva migrans

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Lab diagnosisLab diagnosis ►Stool– look for eggsStool – look for eggs ►Indirect –Indirect –  Iron deficiency anemia on PSIron deficiency anemia on PS  Stool – occult bloodStool – occult blood  EosinophiliaEosinophilia

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TreatmentTreatment ►AlbendazoleAlbendazole ►MebendazoleMebendazole ►PyrantelPyrantel

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Thread worm /Pin wormThread worm / Pin worm (Enterobius Vermicularis)(Enterobius Vermicularis)

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LocationLocation ►Large intestine –cecum and appendixLarge intestine – cecum and appendix

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Life cycleLife cycle ►Humansare the only hostHumans are the only host

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Morphologic formsMorphologic forms ►EggsEggs

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►Adult wormsAdult worms

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Diseases causedDiseases caused ►PruritisaniPruritis ani ►Nocturnal enuresisNocturnal enuresis

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Lab diagnosisLab diagnosis ►NIHswab (National institute of health) forNIH swab (National institute of health) for demonstrating eggsdemonstrating eggs ►Demonstration of adult worms in stoolDemonstration of adult worms in stool

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TreatmentTreatment ►AlbendazoleAlbendazole ►MebendazoleMebendazole ►PyrantelPyrantel

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FILARIASISFILARIASIS (W. bancroftii, B.malayii)(W. bancroftii, B. malayii)

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DistributionDistribution ►World wide –including IndiaWorld wide – including India

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LocationLocation ►Adult worm –lymphaticsAdult worm – lymphatics ►Microfilaria - bloodMicrofilaria - blood

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Life cycleLife cycle ►Humans– definitive hostHumans – definitive host ►Culex/anopheles/aedes mosquito –Culex/anopheles/aedes mosquito – intermediate hostintermediate host

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Morphological formsMorphological forms ►AdultwormAdult worm  Female – 10 cmFemale – 10 cm  Male – shorterMale – shorter  Lay eggs containing embryo (microfilaria)Lay eggs containing embryo (microfilaria)

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►MicrofilariaMicrofilaria  290 microns290microns  Present in peripheral bloodPresent in peripheral blood

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ElephantiasisElephantiasis ►Adult worm causesblockage of lymphaticAdult worm causes blockage of lymphatic channelschannels

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Lab diagnosisLab diagnosis ►MicrofilariademonstrationMicrofilaria demonstration  Parasites seen in blood between 10 pm and 2Parasites seen in blood between 10 pm and 2 amam  Co incides with feeding time of mosquitoesCo incides with feeding time of mosquitoes

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►Adult worm demonstrationAdultworm demonstration  Lymphnode biopsyLymphnode biopsy

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TreatmentTreatment ►DEC (Diethylcarbamazine) helpstreatDEC (Diethylcarbamazine) helps treat filariasisfilariasis ►But elephantiasis once developed cannot beBut elephantiasis once developed cannot be curedcured

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CestodesCestodes Taenia SaginataTaenia Saginata TaeniaSoliumTaenia Solium E. GranulosusE. Granulosus

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Taenia Saginata/Taenia soliumTaeniaSaginata/Taenia solium (beef tapeworm/pork tape worm)(beef tapeworm/pork tape worm) ►DistributionDistribution ►LocationLocation ►Life cycleLife cycle ►Diseases causedDiseases caused ►PathogenesisPathogenesis ►Lab diagnosisLab diagnosis ►TreatmentTreatment

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DistributionDistribution ►SaginataSaginata ►World wide inbeef eating populationWorld wide in beef eating population  Not seen in India in regions where beef is notNot seen in India in regions where beef is not eateneaten ►SoliumSolium  World wide in pork eating populationWorld wide in pork eating population

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LocationLocation ►Small intestineSmall intestine

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Life cycleLife cycle ►SaginataSaginata Definitive host – humansDefinitive host – humans  Intermediate host – cows and buffalosIntermediate host – cows and buffalos ►SoliumSolium  Definitive host – humansDefinitive host – humans  Intermediate hosts - pigsIntermediate hosts - pigs

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Morphological formsMorphological forms ►Adultworm (saginata)Adult worm (saginata)  Inside humansInside humans  Segmented – called proglottids – contain eggs –Segmented – called proglottids – contain eggs – passed in fecespassed in feces

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Morphological formsMorphological forms ►Adultworm – soliumAdult worm – solium  Similar except for additional rostellum / hookletsSimilar except for additional rostellum / hooklets

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►Eggs (same forboth)Eggs (same for both)  Spherical and bile stainedSpherical and bile stained

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Life cycleLife cycle CYSTICERCU S

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Diseases causedDiseases caused ►Diseaseis asymptomatic and remainsDisease is asymptomatic and remains undiagnosedundiagnosed ►Problem is that humans may act asProblem is that humans may act as occasional intermediate hosts in case of T.occasional intermediate hosts in case of T. soliumsolium  Called cysticercosisCalled cysticercosis  Patients present with seizures/convulsionsPatients present with seizures/convulsions

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Lab diagnosisLab diagnosis ►Notreally possible!!Not really possible!! ►Unless there is cysticercosisUnless there is cysticercosis  CT SCANCT SCAN  BiopsyBiopsy

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TreatmentTreatment ►MepacrineMepacrine

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Echinococcus GranulosusEchinococcus Granulosus (Dogtape worm)(Dog tape worm)

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DistributionDistribution ►World wideWorld wide ►Wheresheep and cattle are bredWhere sheep and cattle are bred ►There must be a close association betweenThere must be a close association between humans, sheep and dogshumans, sheep and dogs

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LocationLocation ►LiverLiver ►LungsLungs ►Wherever embryos settleWhereverembryos settle

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Life cycleLife cycle ►Dogis definitive hostDog is definitive host ►Sheep are intermediate hostsSheep are intermediate hosts ►Humans are accidental intermediate hostsHumans are accidental intermediate hosts

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Morphological formsMorphological forms ►AdultwormAdult worm  Inside definitive hostsInside definitive hosts  Has head, neck and stobilaHas head, neck and stobila  Has 4 segmentsHas 4 segments  Head has suckers (rostellum)Head has suckers (rostellum)

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►EggsEggs  Indistinguishable fromT. saginata/soliumIndistinguishable from T. saginata/solium

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►Larva (hydatid cyst)Larva(hydatid cyst)

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Diseases causedDiseases caused ►Hydatidcyst can remain undetected forHydatid cyst can remain undetected for many yearsmany years ►It causes symptoms depending on theIt causes symptoms depending on the organ in which it has formedorgan in which it has formed ►Rupture of cyst can cause anaphylacticRupture of cyst can cause anaphylactic shockshock

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Lab diagnosisLab diagnosis ►Casoni’stestCasoni’s test ►EosinophiliaEosinophilia ►Serological testsSerological tests ►Examination of cyst fluidExamination of cyst fluid ►CT scan, USG, X rayCT scan, USG, X ray

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TreatmentTreatment ►Surgical removal withoutruptureSurgical removal without rupture

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TREMATODESTREMATODES ►Least commonly reportedin IndiaLeast commonly reported in India ►Refer to examples at the starting of thisRefer to examples at the starting of this lecturelecture ►Detailed discussion is beyond the scope ofDetailed discussion is beyond the scope of this lecturethis lecture

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Thanks !!!Thanks !!! ►LIKETHIS LECTURE!!!!LIKE THIS LECTURE!!!!

Parasitology

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